scholarly journals RADI-12. LEPTOMENINGEAL FAILURE AFTER PREOPERATIVE VERSUS POSTOPERATIVE RADIOSURGERY

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i24-i24
Author(s):  
John Fiveash ◽  
Kristen Riley ◽  
James Markert ◽  
Bart Guthrie ◽  
Paul Foreman ◽  
...  
Keyword(s):  
Cranial Nerves ◽  
Cauda Equina ◽  
Target Volume ◽  
University Of Alabama ◽  
Leptomeningeal Seeding ◽  
Dural Enhancement ◽  
One Year ◽  
The University ◽  
The Brain

Abstract INTRODUCTION: Postoperative stereotactic radiosurgery (postop SRS) is potentially complicated by difficulty defining the target volume and the risk of leptomeningeal seeding at the time of surgery. It is hypothesized that preop SRS may render cells less viable to disseminate in the leptomeningeal space. This retrospective study compares the leptomeningeal dissemination (LMD) rate for preop versus postop radiosurgery METHODS: We identified 140 patients with brain metastases who underwent resection and radiosurgery at the University of Alabama at Birmingham including 91 postop patients (2005–2015) and 49 preop patients (2011–2018). The preop group included 19 patients enrolled in a phase I trial of preoperative radiosurgery (12–15 Gy) for tumors 2–6 cm in greatest diameter. In that study 15 Gy was found to be safe in the preop setting but further escalation was not attempted. An additional 30 patients received preop SRS off-study (median dose 15 Gy). The median postop dose was 16 Gy. LMD recurrence was defined as focal pachymeningeal or diffuse leptomeningeal enhancement of the brain, spinal cord, or cauda equina, dural enhancement beyond 5 mm from the index metastasis, subependymal enhancement, or enhancement of cranial nerves. This definition is not limited to carcinomatosis. All events were categorized and confirmed by at least two physicians. RESULTS: 40/140 (29%) patients developed new focal or diffuse LMD. Preop SRS was associated with a higher freedom from leptomeningeal recurrence (84% vs 60% at one year, p=0.021 Breslow, p=0.128 log-rank). Since later LMD may not be related to surgery, a second analysis censoring follow-up at one year was performed and confirmed this trend (p=0.008 Breslow, p=0.014 log-rank). CONCLUSIONS: Preoperative SRS is associated with a reduction in the risk of LMD compared to postop SRS. Focal pachymeningeal dissemination may not always be recognized as related to surgery. A randomized trial of preop vs postop SRS is warranted.

Prospective evaluation for gastrointestinal bleedings at the University Hospital St. Pölten – one year of follow-up

2019 ◽  
Author(s):  
M Stättermayer ◽  
F Riedl ◽  
S Bernhofer ◽  
A Stättermayer ◽  
A Mayer ◽  
...  
Keyword(s):  
University Hospital ◽  
Prospective Evaluation ◽  
One Year ◽  
The University

Prospective Staged Volume Radiosurgery for Large Arteriovenous Malformations: Indications and Outcomes in Otherwise Untreatable Patients

Neurosurgery ◽  
2006 ◽  
Vol 58 (1) ◽  
pp. 17-27 ◽  
Author(s):  
Sait Sirin ◽  
Douglas Kondziolka ◽  
Ajay Niranjan ◽  
John C. Flickinger ◽  
Ann H. Maitz ◽  
...  
Keyword(s):  
Target Volume ◽  
Neurological Deficits ◽  
University Of Pittsburgh ◽  
Brain Avm ◽  
Last Stage ◽  
Two Stages ◽  
The University ◽  
Median Margin ◽  
Median Interval

Abstract OBJECTIVE: The obliteration response of an arteriovenous malformation (AVM) to radiosurgery is strongly dependent on dose and volume. For larger volumes, the dose must be reduced for safety, but this compromises obliteration. In 1992, we prospectively began to stage anatomic components in order to deliver higher single doses to symptomatic AVMs >15 ml in volume. METHODS: During a 17-year interval at the University of Pittsburgh, 1040 patients underwent radiosurgery for a brain AVM. Out of 135 patients who had multiple procedures, 37 patients underwent prospectively staged volume radiosurgery for symptomatic otherwise unmanageable larger malformations. Twenty-eight patients who were managed before 2002 were included in this study to achieve sufficient follow-up in assessing the outcomes. The median age was 37 years (range, 13–57 yr). Thirteen patients had previous hemorrhages and 13 patients had attempted embolization. Separate anatomic volumes were irradiated at 3 to 8 months (median, 5 mo) intervals. The median initial AVM volume was 24.9 ml (range, 10.2–57.7 ml). Twenty-six patients had two stages and two had three-stage radiosurgery. Seven patients had repeat radiosurgery after a median interval of 63 months. The median target volume was 12.3 ml. (range, 4.2–20.8 ml.) at Stage I and 11.5 ml. (range, 2.8–22 ml.) at Stage II. The median margin dose was 16 Gy at both stages. Median follow-up after the last stage of radiosurgery was 50 months (range, 3–159 mo). RESULTS: Four patients (14%) sustained a hemorrhage after radiosurgery; two died and two patients recovered with mild permanent neurological deficits. Worsened neurological deficits developed in one patient. Seizure control was improved in three patients, was stable in eight patients and worsened in two. Magnetic resonance imaging showed T2 prolongation in four patients (14%). Out of 28 patients, 21 had follow-up more than 36 months. Out of 21 patients, seven underwent repeat radiosurgery and none of them had enough follow- up. Of 14 patients followed for more than 36 months, seven (50%) had total, four (29%) near total, and three (21%) had moderate AVM obliteration. CONCLUSIONS: Prospective staged volume radiosurgery provided imaging defined volumetric reduction or closure in a series of large AVMs unsuitable for any other therapy. After 5 years, this early experience suggests that AVM related symptoms can be stabilized and anticipated bleed rates can be reduced.

Nonvestibular Schwannomas of the Brain: A 7-Year Experience

Neurosurgery ◽  
2002 ◽  
Vol 50 (3) ◽  
pp. 437-449 ◽  
Author(s):  
Sajjan Sarma ◽  
Laligam N. Sekhar ◽  
David A. Schessel
Keyword(s):  
Tumor Resection ◽  
Cranial Nerves ◽  
Abducens Nerve ◽  
Functional Results ◽  
Senior Author ◽  
Karnofsky Performance Scale ◽  
Lumbar Drain ◽  
Scale Scores ◽  
The Brain

Abstract OBJECTIVE: Nonvestibular schwannomas are uncommon tumors of the brain. Trigeminal nerve schwannomas are the most common of this group, followed by glossopharyngeal, vagal, facial, accessory, hypoglossal, oculomotor, trochlear, and abducens nerve schwannomas, in descending order of frequency. We present a series of nonvestibular schwannomas that were surgically treated during a 7-year period. METHODS: Forty-six patients with schwannomas of Cranial Nerves V (26 cases), VII (7 cases), IX, X, and XI (9 cases), XII (3 cases), and III (1 case) were microsurgically treated by the senior author (LNS) during a 7-year period, from 1993 to 2000. The clinical presentations, operative approaches, complications, and results were studied. RESULTS: Forty-five patients underwent gross total tumor resection in the first operation. One patient who had undergone subtotal tumor resection in the initial operation experienced a large recurrence after 4 years, and gross total tumor resection was achieved in the second operation. There were no postoperative deaths. Postoperative morbidity consisted of cerebrospinal fluid leaks for 5 patients (3 patients required a second operation to repair the leak, and 2 patients responded to lumbar drain placement), meningitis for 3 patients (2 cases were aseptic and 1 involved bacterial meningitis, which resolved with antibiotic therapy), vasospasm requiring angioplasty for 1 patient, temporary hemiparesis for 2 patients (who experienced good recoveries), and permanent hemiparesis for 1 patient. New cranial nerve deficits were observed for 24% of patients but were usually partial. The mean follow-up period was 33.3 months (range, 0.2–93 mo). No patient experienced tumor recurrence after complete tumor removal. The patient who experienced regrowth of the tumor did not exhibit recurrence after the second operation. The Karnofsky Performance Scale scores at the latest follow-up examination were 80 or more for 45 patients (98%) and 70 for 1 patient. CONCLUSION: Nonvestibular schwannomas can be treated via microsurgical excision, with excellent functional results. Recurrence is rare after total tumor excision, although much longer follow-up monitoring is required.

scholarly journals A Follow-Up Study of the Factors Shaping the Career Choices of Library School Students at the University of Alabama

2010 ◽  
Vol 50 (1) ◽  
pp. 35-47 ◽  
Author(s):  
Stephanie D. Taylor ◽  
R. Alexander Perry ◽  
Jessica L. Barton ◽  
Brett Spencer
Keyword(s):  
Career Choices ◽  
University Of Alabama ◽  
School Students ◽  
Follow Up Study ◽  
Library School ◽  
The University

Successful treatment of disseminated granulomatous aspergillosis in an apparently immunocompetent host

2020 ◽  
Vol 50 (4) ◽  
pp. 346-349 ◽  
Author(s):  
Umang Agrawal ◽  
Pratik Savaj ◽  
Kanishka Davda ◽  
Rajeev Soman ◽  
Anjali Shetty ◽  
...  
Keyword(s):  
Granulomatous Inflammation ◽  
Surgical Excision ◽  
Immunocompetent Host ◽  
Short History ◽  
Normal Individuals ◽  
History Of ◽  
One Year ◽  
Work Up ◽  
The Brain

A young Indian man presented elsewhere with a short history of haematuria and cough. Investigations revealed renal and pulmonary lesions. Histopathology of these lesions was reported as mucormycosis. He consulted us two months after onset of symptoms, asymptomatic and clinically well, having received no treatment. In view of clinico-histopathological discordance, a review of the biopsy slides was advised but the patient refused further work-up at that time. One week later, however, he was admitted with left hemiparesis. Brain imaging showed an abscess. He underwent surgical excision of the brain abscess and nephrectomy. Review of previous slides showed septate fungal filaments with granulomatous inflammation. Intraoperative cultures grew Aspergillus flavus. He received voriconazole for one year and is well at his two-year follow-up. His immunological work-up was negative for immunodeficiency. This case illustrates that granulomatous aspergillosis may be an indolent infection in apparently normal individuals and reiterates the importance of interpreting diagnostic reports in conjunction with clinical features.

Characteristics and Management of Vertical Deviations in an Urban Academic Clinic: A Retrospective Analysis

2016 ◽  
pp. 123-131
Keyword(s):  
Treatment Recommendations ◽  
Referral Source ◽  
Effective Treatment Option ◽  
Small Magnitude ◽  
Vertical Deviation ◽  
State College ◽  
Vision Rehabilitation ◽  
One Year ◽  
The University

Background: The purpose of this retrospective study was to determine the characteristics of patients with vertical oculomotor deviations, and furthermore to examine the efficacy of optometric vision rehabilitation (OVR) as a treatment for vertical deviations. Methods: Medical records were reviewed for 512 patients who were diagnosed with a vertical deviation at the University Eye Centerm (UEC) at the SUNY State College of Optometry from the years 2005-2010. Presenting complaints, referral source, and descriptions of the deviations were analyzed. Previous interventions were noted, and treatment recommendations were reviewed. Of those patients for whom OVR was recommended, the initial therapeutic results and follow-up were evaluated. Results: The most common presenting complaint was diplopia (“double vision”) (42%), and the most common referral source was a self-referral (59%). The most prevalent vertical deviation was a constant, comitant, hypertropia of small magnitude (1-5Δ). Concurrent horizontal strabismus was present in 52% of the patients. Previous interventions included extraocular muscle surgery, prism, and OVR. Treatment recommendations included prism (37%), OVR only (22%), or OVR and prism (14%). For those patients who were recommended for OVR only, 37% completed the OVR. Of those who were recommended OVR and prism, 39% completed the OVR. Symptoms were reduced in 78% of those who either completed OVR only or received OVR and prism treatment. More of the patients who completed the OVR showed maintenance of their improvements (38% of OVR only and 44% of OVR and prism) at greater than one year follow-up. Conclusions: The present findings provide critical information that can be used for optimal referral and treatment. Optometric vision rehabilitation provided an effective treatment option.

CRANIOSTENOSIS

PEDIATRICS ◽  
1962 ◽  
Vol 30 (1) ◽  
pp. 57-70 ◽  
Author(s):  
John Mark Freeman ◽  
Shirley Borkowf
Keyword(s):  
Cosmetic Results ◽  
Detectable Difference ◽  
One Year ◽  
The Brain

Thirty-four cases of craniostenosis are presented. Of the 19 cases of sagittal stenosis, 14 were unoperated. Four of these patients were retarded. This retardation was not believed to be caused by the craniostenosis. Of the five operated patients, three were seen at follow-up, and one was retarded. There was no difference in cosmetic results between the operated and unoperated cases. In the four cases of coronal stenosis there was no detectable difference in mental or cosmetic results between the operated and unoperated cases. In the combined stenosis group of 11 cases, four persons developed papilledema. There was no difference in mental or cosmetic results between those operated on before one year of age and those operated on when symptoms became evident. There is evidence to suggest that in sagittal and coronal stenosis growth of the brain is not restricted by closure of the suture. It would thus seem that there is little need for prophylactic operations but that instead operations should be performed only for papilledema or very severe deformity.

scholarly journals Pathological laughter in a patient with trigeminal neurinoma

2002 ◽  
Vol 60 (4) ◽  
pp. 1000-1002 ◽  
Author(s):  
André G. Machado ◽  
Paulo Henrique Aguiar ◽  
Raul Marino Jr
Keyword(s):  
Nerve Palsy ◽  
Large Tumor ◽  
Pathological Laughter ◽  
History Of ◽  
Significant Compression ◽  
One Year ◽  
The One ◽  
The Right ◽  
The Brain

We present a 47-year-old woman with a long history of anxiety and a more recent history of shock-like facial pain and episodes of laughter without any motivation. She could not explain the laughing bursts and did not have a sense of mirth preceding it. On neurological examination she presented a VI nerve palsy and trigeminal hypoesthesia (V2 and V3) on the right side. Magnetic resonance imaging exhibited a large cystic lesion on the right middle fossa causing significant compression on the brain stem. A frontoorbitozygomatic and pretemporal combined approach was performed. During intra and extradural exploration a large tumor was found on the trigeminal nerve. The whole lesion was resected, revealing to be a neurinoma on pathological exhamination. She maintained a VI nerve palsy but had complete remission of the unmotivated laughing episodes during the one year follow up.

Twenty-five-Year Follow-up of Short-term Cancer Research Trainees at the University of Alabama at Birmingham: a Brief Report

2018 ◽  
Vol 34 (5) ◽  
pp. 1010-1013 ◽  
Author(s):  
Renee A. Desmond ◽  
Raam Venkatesh ◽  
Luz A. Padilla ◽  
Casey L. Daniel ◽  
Allison G. Litton ◽  
...  
Keyword(s):  
Cancer Research ◽  
University Of Alabama ◽  
Short Term ◽  
The University

The Vision Outreach Project: A Pilot Project to Train Teachers of Visually Impaired Students in Alabama

1991 ◽  
Vol 85 (5) ◽  
pp. 222-225 ◽  
Author(s):  
M.J. Sanspree ◽  
C. Allison ◽  
R.M. Gargiulo
Keyword(s):  
Urban Areas ◽  
Visually Impaired ◽  
Pilot Project ◽  
University Of Alabama ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
Visually Impaired Students ◽  
One Year ◽  
The University ◽  
Future Topics

This article describes the Vision Outreach Project—a one-year pilot project for training teachers of visually impaired students at the University of Alabama at Birmingham. The project used video modules to provide distance education in rural and urban areas and incorporated students’ evaluations of future topics that are needed on videotapes to supplement classroom instruction.

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